Hi everybody and welcome to another episode of Airway First, the podcast from the Children's
Airway First Foundation. I'm your host, Rebecca Basma. Our guest today is Dr. Steve Carcensen.
He is an airway-centric dentist who has treated patients with sleep apnea and snoring in Bellevue,
Washington since 1988. He's the consultant to the ADA for sleep-related breathing disorders.
He's trained at UCLA's mini-residency in sleep and is a diplomat of the American Board of Dental
Sleep Medicine. Dr. Carcensen lectures internationally, directs sleep education at Airway Technologies
and the Panky Institute, and is a guest lecturer at Spear Education, University of the Pacific,
and Louisiana State Dental Schools. He was a board member for the AADSM,
Editor of Dental Sleep Practice Magazine, and co-authored a clinician's handbook of Dental Sleep
Medicine. You can find out more about Dr. Carcensen at seattlesleepeducation.com and
at stevecarcensendds.com. And now, I hope you enjoy my interview with Dr. Steve Carcensen.
Thank you so much for joining us on the podcast. I really appreciate it.
Oh, sure. It's a pleasure to talk to you anytime, Rebecca.
Thank you. Thank you. All right. So before we dig in, let's talk about just so everybody kind of has
a baseline of what we're discussing. What actually is dental sleep medicine?
That's a great question, actually. And I got a little background for you because
as part of Dental Sleep Practice Magazine, where I'm the Chief Dental Editor, I just interviewed
dentists who started the American Academy of Dental Sleep Medicine. It was called the
Sleep Disorders Dental Society back then, 30 years ago this year. Okay. So I was asking Dr.
Rogers, I said, you know, tell me about the term dental sleep medicine. Kind of the same question
you just asked me. And he said that he coined the term about 20 years ago to describe how dentists
interact with physicians and how do we blend them together? Because we have dentistry and we have
medicine in this specific field of sleep. And how it got started back then is the
physicians were figuring out how to help people who were sleeping badly. And it turned out they
were breathing badly when they were sleeping. And so they discovered the disease of obstructive
sleep apnea came up with some treatments and dental medicine provided treatment for that.
At the same time that CPAPs provided treatment for that. So dentists were involved from the
beginning of treating bad breathing at night for adults. It's all adults. And so they said,
well, how do we label ourselves? Because we're not just, you know, at the time they were thinking
not just dentistry. So they decided to call dental sleep medicine. So it's really just trying to describe
the intersection between what dentists can do with primarily many of their advancement devices in
adults and what physicians can do for the medical side of the disease. Okay. So it's a,
it's, now it's an imperfect time, but it's, it's what we think about these. We were talking about
30 years ago. Yeah. So can dentists actually diagnose sleep apnea? Not currently. No, what
disease of sleep apnea is a medically recognized problem. So the role that physicians have to
diagnose is important because there's a lot of interactions with other medical problems that
dentists aren't trained about at all. What dentists can diagnose is a mechanical problem with breathing.
In other words, we can tell whether somebody snores, we can tell whether somebody's airways
closing, but the medical situation of obstructive sleep apnea is a medical diagnosis. We need
physicians for that. Okay. And typically a physician, you would, you would recommend somebody
to a physician or tell them, you know, Hey, this is what I see. And you would
communicate with that physician somehow. Yeah. The biggest problem we have in the world really is,
and it's taught by United States and adults so far, we're going to talk about kids here a little bit.
I know we are. Yeah. Oh, yeah. We've heard about adults for just a second because that kind of sets
a stage. And for adults, what we have is that 25 years ago or so when I was learning about all
this stuff, they told me that 15% of the adults that have sleep apnea have actually been diagnosed.
Today in 2022, if you go to the best experts, they may grudgingly acknowledge that 20% of the
people that should be diagnosed have actually been through a process. So we're not getting
anywhere and getting adults diagnosed over these 25 years. So that's one of the problems we have
is that we only have a few physicians doing the diagnosis. So what the interest can do is what
we're, what is, we can make more people aware that they have a breathing problem and facilitate
their diagnostic process. And that's changed a whole bunch in the last even couple of years.
COVID has drawn a new set of rules up for diagnosis. Because the in-person visits have gone to be
minimized. We learned of when we were forced to do telehealth, that in fact, telehealth works pretty
good. That's something that's more consult, consultative like sleep medicine and able to be
tested in remote facilities. In the early days, the only testing they had was in specialized
rooms and hospitals. Nowadays, that's still done, but it's done less often because we have
home ways of testing at home. So you can get a sleep lab level quality at home and then kind of a
real life environment. Not quite accurate statement. Home, real life environment, those two true
quality sleep lab quality, not quite there yet. But it's getting here because the technology is
getting better, faster, cheaper. With a big company out of France, there's a lot of technology,
they've really jumped on the board for these remote monitoring devices. And they have a
pad in fact that goes underneath a mattress that measures many of the same biosignals,
kind of a new term for us all biosignals. They measure the same biosignals that we get out of
the quote, official unquote, home sleep apnea test. And because it's all in the cloud,
they just released a study that had 68,000 patients over 11.6 million sleep nights.
The biggest bunch of data that's ever been gathered about sleep. And they found out that 20%
of the sleep tests nights were incorrect. So back to your question, sleep lab quality at home,
not quite because we have devices that accurately measure the biosignals,
but we have to think that one out of five of those nights of testing is probably inaccurate.
And that means that if you go to your sleep physician, say you're screened by your dentist
and oh great, great. You know what? That story is a problem. So I'll go and get tested.
And I get hold of my physician, a sleep physician, and the physician says, great,
I'll send you a monitor. You strap it on, we'll learn how you do. And you get one night with that.
What if that's one of the five nights? What if that's your five? Yeah.
Yeah. Now we have the worst possible way of a false negative because we have a patient who has
complaints, I'm snoring, I'm not feeling well, a dentist who says, dude, you got to do something
about this. The patient actually becomes one of the 20% and they go on and seek a diagnosis.
But the test is faulty. And so the test says, no, patients, you don't have a diagnosis. You don't
have a disease. Well, now what's the yes? The sleep physician doesn't have any place to go
because their test says no. The patient still says, okay, dentist, you told me I was in trouble.
Now they said I'm not in trouble. So what am I supposed to do about this?
Right. So it's a conundrum that we haven't quite solved yet. But the solution is going to be
the fact that we can do multiple nights testing now for low money and low trouble. And if that's
the case, then we can accept that first night. Oh, that doesn't line up so much.
That's not a way.
All right. It all comes down to money on that.
And insurances, are we at the point that insurances will pay for or supplement these tests at home?
Sometimes what the common accepted protocol right now is that if the clinical symptoms don't line
up with the home sleep tests, then that qualifies the patient to go into that in-lab,
very detailed study. But that costs thousands of dollars for that study.
And so the insurance companies, they don't pay for that. So what is going to happen, I think, is
they'll, the insurance companies will say, okay, great, doctor, feel free to have the patient do
multiple nights at home so we can eliminate that one in five event. But that data is all brand
new in the insurance companies. They don't change quickly.
Right.
Most of the sleep physicians I work with here in the Seattle area do one night tests.
And if they don't qualify that way, if it doesn't line up clinically, it doesn't make sense to them
that into the sleep lab, the patient isn't right it. But patients don't like those sleep tests.
Right.
And so it's just a problem. Another one physician on here does three nights all the time
because he's aware of the details of this stuff. But I'm not sure how that's paid for
because insurance companies don't tend to like to pay extra.
Right. Right. Understood. So when it comes to adults, I know that traditionally, and we've had
another guest on that's spoken about this, the CPAP, this is the door to go, the outside, I don't
know what you call it, the equipment. But I heard you speak about the TAP system. So what exactly
is the TAP system? Is that an alternative? Sure. Well, we got to back up again.
Okay.
So when they discovered the problem of obstructive sleep apnea, what Dr. John Remers came up with
is, wow, these people's airway collapses behind their tongue. And so the treatment that he and Dr.
Colin Sullivan came up with is, well, if we put a little bit of air pressure
into the upper airway through the nose, then we can splint that airway open so it doesn't
collapse, we'll be briefed. Okay, great. That became CPAP. And the measurement that they used
to, as the kind of the dragon to fight in sleep apnea is called the apnea hypopnea index. They
measure how many times does somebody stop breathing, how many times does their breathing get restricted,
and they divide by a time factor, and they have an index. So that's our score system.
Okay.
If our goal is to fix the score down to normal, CPAP is the very best thing possible,
because it fixes the AHI, the apnea hypopnea index, the score. It fixes that.
Okay.
But the problem is, is it comes with a bunch of baggage. And so the patients don't like it.
That, you know, of course some patients do like it, but only about 30% of people,
according to most studies, actually use the CPAP the way they're supposed to.
So we have a treatment that does, it's very effective when it's being used.
When it's only being used 30% of the time, correct. But it's still labeled gold standard
treatment. And I think that label has to go away because there's, it's not possible to call
something gold standard. It's only used 30% of the time.
Thanks.
And study after study nowadays is showing that the overall health impact of CPAP is less of
because of this lack of use.
Okay.
So back to the early 80s, and already by the early 80s, the dentists were saying, well,
wait a minute, CPAP isn't being used very well. People don't like that back then,
even bigger and noisier, more cumbersome devices.
So, so very smart dentists, Tom Mead and Albuquerque, Keith Thornton and Dallas, several,
Alan Lowe up in, in Victoria and Coover BC and others were coming up with these ways of holding
the airway open, just thinking about the 3D anatomy.
Isn't we have a movable lower jaw or mandible and jut forward.
And soft tissues like the base of the tongue are attached to that movable bone.
So if we move the bone forward, maybe we get the soft tissues out of the way and do the
same thing the CPAP was trying to do. So oral appliances were developed to do that very thing.
And that Thornton adjustable positioner named after Keith Thornton, who invented it, called the tap,
was one of the earliest devices. And so the tap system, I think is great because of a couple
things I'll tell you about a second, but that is really just part of what is now 150 or so
FDA cleared devices, all aimed to do the same thing, which is to keep the airway from collapsing
while people sleep. 150 approved devices. So we're in that range. I don't know the exact
number of this. It's close to that number. Had no idea. Because the thing is holding the jaw
forward is the thing, but there's a lot of invention associated with the way to do that.
And that's the big contrast with CPAP. Because although positive air pressure,
PAP, part of those things, it can be applied in several different ways because there's
CPAP, there's BIPAP, there's adaptive PAP, there's all these kinds of things. It's a whole positive
air pressure. But oral appliances have all these different designs because they really were developed
in the hands of creative dentist types. And so or some engineers, but mostly dentists. And so what
they said, well, we could try this little wing or that screw or this kind of mechanism or this hook
or whatever the case may be, that it's all aimed to hold the jaw forward in different and more,
you know, in their view, the most comfortable, the most effective, the easiest to the patients to
adhere to. And the key to it right there is, is it effective for the problem? Does it fix the
AHI score, but also other things? And will the patients accept it? Whereas seat that has to be
accepted by what, how does the mask fit? How quiet can we make the pump? You know, those kind of
things. The oral appliances being customized by dentists who completely understand the anatomy
and the function of the, that part of the body, the oral cavity and the head and neck, they can say,
well, this wing would be more comfortable. This design would address this muscle issue. You know,
this way we can give people to adjust it will be something that they'll actually use. So they
put the tap stay in. Does the, does the tap stay in? Is it an oral appliance you wear all the time
or is it just when you sleep? Oh, you only need to support the airway during sleep.
Okay. Yeah. Well, we're all awake. The muscles of our airway resist negative pressures of breathing.
When you breathe in, you pull the negative pressure into your chest to fill your lungs.
Well, so we have muscle function to keep that from collapsing in daytime.
Nighttime is when that muscle function goes away and taps and others keep that from collapsing.
So the tap has a benefit because it holds the jaw forward with a little connector in the front.
So it's free moving side to side, but not forward and back. So the top can't fall backwards while
somebody sleeps. And then the other thing that tap has going forward that I really like is that
it comes with a removable silicone mouth shield. So it goes under your lips and makes
your nose breather. The nose breathing is the key to health. Yes, it is. Yeah. And we're going to
track that's going to transition us into talking about kids because Dr. Thornton said, wait a minute,
we emphasize nose breathing for kids all the time. So what about these adults and these appliances?
What, how can we make sure that happens? They came up with a silicone cover into tap system
that makes you an obligate nose breather. And that turns out to have so many health benefits.
Now we're going for far more than just fixing the score of the AHI. We're actually helping improve
physiology by making sure people breathe through their nose. Nice. Nice. So yeah, that does.
That transitions right into where we're going to go, which is talking about kids. Hey, look at that.
Kids, kids and kids health. Because we know that as adults, what we've heard, right? We've all heard
what not sleeping can do to you and all the health impacts. But we really haven't,
but until recently talked about reading and sleep and the way they correlate with children
and their health. As they're growing, but then that's what's going to manifest and cause all
these health implications as they get older. So when we're talking about kids and we're talking
about, let's just start with sleep specifically. Why is that so important for kids?
Well, you know what? You know the really interesting part about that, Rebecca? They don't really know.
We don't know why. We don't know the function of sleep in great detail. There's been big volumes
written. One of the best is by Matthew Park, Matthew Walker. Matthew Walker, yeah. Why are we sleeping?
Why are we sleeping? Yes. But even that's about adults. And so the key about kids is so difficult
to test. Sleep medicine came around because of adult problems. Adults having troubles in hospitals,
adults being observed by physicians. So the rules are written for measuring adults. The
tools were developed to measure adults. And somewhere along the way, of course, pediatricians
and physicians said, look, there's little kids out there that don't seem to be sleeping well either.
And there seems behavioral troubles. And in my practice, like for example, you know, I have 55
year olds in my practice that have chronic disease, chronic inflammatory related diseases
like cardiovascular disease and diabetes. Where did that come from? It came from decades of
struggling to breathe at night time. So if I was 55 year old in my practice, at one point,
they were 5.5 year old. Right. And so could there be a root cause of some of these adult problems
in children? Well, it makes logical sense. Then you kind of try to go to medicine and science
and think, how are we going to figure this out? Right. And the only good way to figure it out,
I mean, oh, not good. The only incontrovertible way of doing this is to gather up a bunch of
5.5 year olds, get a figure, figure out whether they breathe badly at night time,
put half of them into some kind of treatment to fix that, and leave the other half untreated.
And then wait until they're 55 and see what happens. Well, there's many things wrong with that.
You'll never be able to do that study because once you diagnose a child, especially with a disease,
they don't have the, they can't be the 55 year old says, I'm not going to treat this.
They, you know, you can't ethically withhold treatment from some of them. So you have to
randomize control trials. All we can do is we can look at populations of kids who were treated
and populations of kids whose families decided that treatment wasn't going to be possible for them
for whatever reason that is. And then look and see. So that makes matching populations a little
difficult. Some of it's been done. Karen Bynik has done a big study in a town in England that's now
about 20 years old. So we have some pretty good data about what goes on, but what we don't have to
rely upon is the fact that we can consider a child who doesn't breathe well to be less healthy than
a child who does breathe well. That makes sense. We don't make science to tell us more than that.
So let's figure out why they don't breathe well. And if they don't breathe well from bad habits,
like for some reason they just developed a mouth breathing habit, maybe we can fix that.
You're listening to Airway First with today's guest, Dr. Steve Carcinton.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation, and treatment of all children's airway
disorders before the age of six on our website at childrensairwayfirst.org. You can also find a
ton of great resources for parents on our website, including videos, blogs, recommended books,
comprehensive medical research, a parent's forum, and so much more. As a reminder,
this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child
might have an airway issue, contact your pediatric airway dentist or pediatrician.
And now back to our interview with Dr. Stephen Carson.
Right. And we try and measure what's going wrong. All we're really doing there, Rebecca,
is we're measuring a symptom. Because if they don't sleep well, it's because they don't breathe well.
Right. So why would we treat the sleep problem? Let's treat the breathing problem. And so why
wouldn't they breathe well? We have to think backwards on that. And now we run into a big problem.
Because if they don't breathe well, it could be a habit, but it could also be an underdevelopment
of the, well, Dr. Kevin Boyd, somebody else you're going to have on your program, no doubt,
because he's an expert. Oh, yes. He's also on our board. Yeah. All those things. Kevin,
we're so grateful in the world to have a Kevin Boyd. Yes. So he came up with a term called the
craniofacial respiratory complex. So you have RC. Then I told Kevin, I said, I love that concept.
I love the thought of a craniofacial respiratory complex as the thing that we have to think about.
I don't love the term because it's hard to say. It's very hard to say.
But, you know, can you briefly explain to people that don't know what that is?
Of course. Yeah. So I'll explain the term craniofacial respiratory complex.
So we have the cranium, the skull, that's where your brain is, and that's the base of things.
That's what things grow from. Right. The facial portion is what we see from the
front. It's the, your cheekbones, it's your, the support of your cheek and the,
how far forward your nose is, how far forward your teeth are, where does your chin go?
And how wide is this? So it's the three dimensional structure that's the face. Okay.
Well, what's, what's inside the face, of course, are things that dentists pay attention to,
like teeth and by instance, smiles, but also those same bones that support what we see as the face
and the nose and the teeth supports the airway. So as, and we dentists and ENT doctors as well,
but mostly dentists are the specialty in medicine for how that face develops. We're the only part of
medicine that can go into a 5.5 year old, recognize that that bone is not growing to support the
airway properly and do something about it. Now we're not talking about syndromeing kids,
kids that have a genetic problem where they're, you know, they just have a growth issue that's
by their genes. We're talking about normal kids, millions of millions of normal kids.
And then I don't mean normal, you know, anyway, so, so regular kids, regular kids, there's a bit
of one. All right. So, so, so if you get in a regular kid in a practice, in a dental practice,
where the dentist is looking at the structure of things, cranium, we're not going to do much about
cranium. We can do, we can do a lot about facial. And we can do a lot about respiratory, the way
that the child is breathing. Because we can measure that and we can look at it and we can,
we can ask about that and we can notice things. No, do things such as like the, the jaw being too
far back or there's not enough room or what kind of things do you notice? Yeah, we can notice the
first office, are they breathing through their nose or their mouth? If, if the child is sitting in
your dental chair or sitting on your reception room or in your family and they're breathing through
their mouth, that's wrong. That's a sign. Yep. Because when the mouth is open and therefore
breathing through the mouth, there's several bad things that happen. Today I will grab things.
One of them is the tongue can't be in the root of the mouth because if it is, you can't breathe
through your mouth. Right. At least your tongue is in the floor of your mouth. Okay. Well, if your
mouth is open, your chin down, mouth open, your cheeks now put a little bit of pressure on the width
of the upper jaw, the menacella. Yeah, because the tongue is in the floor of the mouth, it can't
resist that pressure on the palate. So therefore the maxilla is pinched narrow. And when the maxilla
is pinched narrow, the palate is pushed upwards. It's pushed upwards into the nose.
So now we have less room in the nose. And we're shook. I know everybody's going to be doing this
at home. Where should your tongue be, he actually. Your tongue should be in your palate all the time.
Now when I'm talking, my tongue should rest against my palate. And not just the tip of my
tongue up there and behind my front teeth, but my whole body of my tongue should rest against
the whole body of my palate. And in a 5.5 year old, when that happens, then that little bit of
pressure from the tongue resists the pressure from the cheeks and the maxilla grows wider.
The palate looks like the top of the tongue, top of the tongue is flat, big, broad space.
The palate should look like that. It shouldn't be a narrow little canyon.
And because when it is a narrow canyon, it's going upwards and upwards into the nose and it
takes the middle of the nose, the septum bends it over one side. So we end up in a dv.
It's not cherry. And then if you can't breathe well through that smaller space,
the low pressure there makes the soft tissues of the nose, the turbinates and other things that are
involved in the nose. It makes them bigger, which means they even harder to breathe through your
nose. So it's a complex. So the diagnosis isn't that these kids can't sleep well. The diagnosis
is they're breathing badly through a small space. And we dentists can do that. We don't need a sleep
study to tell if this child is not breathing. We don't need a sleep study to know whether the tongue
positioning is or whether the jaw structure is growing too narrow or back too far. So we
diagnose what we can diagnose, which is problems in this cranial facial respiratory complex.
You know, the other cool part about this is we dentists can do something about the growth and
development of the bones. Well, we mostly dentists and hygienists currently aren't trained in how to
deal and do anything about the tongue position or how it's unfunctions or whether the swallow is
correct. So we have our myofunctional therapy colleagues and our speech and language pathology
colleagues to help us with training these little ones to be to function properly into this in this
complex. The dentist can do something about and neither one of those strategies are available
to sleep positions. Okay. Yeah. And you mentioned something that I mean, I understand it now from
working with the Children's Airway Foundation, but y'all aren't trained to look at airways and to
function, I mean, to focus on airways. Yeah. That to me is just mind boggling. I well, we're trained.
We're well, currently we're back and we're not trained enough to focus on airways. We're trained
to focus on the part of the body that controls the airway. But like like orthodox, for example,
our orthodox colleagues are trained currently to see kids in now what Kevin Boyd calls geriatric ages,
you know, like seven and nine, to and see what they're trained to see, which is a beautiful smile,
a bite that looks good, the coordinates with the function of the jaw joints. Those are three great
outcomes for an orthodontic process. Right. Whatever age it is, goodbye, nice smile, coordinated
with the job. Sure. What we have to do though is we have to add in this airway focus. And the
instruction in that is at a hawk at this point, because it's not part of hardly any dental schools,
there's a little bit of work on a sundown school, but not enough. Okay. Part of medicine at all.
Right. And so groups like Children's Air Enforced Foundation, and American Academy of Physical
Medicine and Dentistry, AAPMD, ASAP, ASAP is a group of dentists who have developed a children's
focused education program. I'm very proud of the American Dental Association for caring on the
children's airway initiatives that we started with Dr. Boy and I and others started in 2018.
So we have a growing amount of focus in education of dentists after middle school
to pay attention to this from an airway perspective. You know, as a cranial facial
respiratory complex, not just a good group of teeth, you know. Right. Right. And I'll have links
to everything that you just mentioned in our podcast. So, you know, people can go check all of
that out, which is awesome. One of the things that Dr. Boyd has mentioned, and I know you and I
have talked about this before, as a mom, you know, the first time I heard him say this,
I about fell out of my chair and thought, I'm a horrible parent, because he talks about,
you know, these kids that are 11, 12, 13, where we're taking out teeth and we're putting on
retractive braces. Yeah. Which, you know, I get it. I understand that. But now knowing what these
signs and symptoms are of airway disorders, you know, that's the part as a mom that just sent
me tailspinning going, oh, wow, I missed it on one of my kids. Oh my gosh. So parents that are
at this crossroads, you know, that are being told, this is where we are. This is what you need.
What are some things they can look for to ensure this is the right solution for their child? Because
sometimes it is. But then what are the repercussions if they haven't undiagnosed airway?
Well, one thing, one message we liked for all parents, families, all inclusive, let's just call it
families. Okay. Yeah. Because there's families of all kinds of descriptions, right? Absolutely. So,
so that what families should look at is how early in life can we detect any signs of problems?
And one of the things that's really common is let's call it a five year old, five and a half,
six, seven year old. If the front teeth have a beautiful smile, they're all touching like we
look for an adult teeth, there's no gaps between the teeth. That's a very scary smile.
Because what it tells us is that the bone structure isn't big enough yet. So when a child gets to be
teenager years middle school, and they go to the orthodox and the orthodox says, oh,
we don't have enough room for all of these teeth, we're going to have to pull out teeth and pull
some things back together so we can give you this beautiful smile. So dentists are paying
attention to it anyway, they think, oh, that's horrible. We should never take out teeth. You
know, the extraction is the is the evil part. Well, I agree that extraction is the bad thing to do,
but the problem isn't the teeth. The problems in the cranial facial respiratory problems.
In the structure, in the airway support, right. But that way you have to look earlier in life.
Okay, what are we doing? What's the message? The message is as early in life as possible,
get a pediatric dentist or a dentist, a family dentist who knows about these things,
to give an assessment for breathing in airway. And some orthodox, more and more orthodontist
are understanding this expansion of their oversight. And they're paying attention to
airway as well. That's what a calf is going to be. You know, that's the message out there,
isn't it? Yes, that is. More of these health professionals paying attention to these little
kids early in life. And then we can intervene when we can still grow the bone very easily.
Yes. Because when Kevin sees a little kid who at five or four or three, that has a developing
problem, they can put in a little tiny springy thing. And that bone responds to that. They can
have the kid train on how to work with their tongue when they swallow and the bone responds to that.
And so now when they're in middle school, the orthodontist looks in there and goes,
oh, the teeth are kind of twisted a right a bit. Let's line them up right so we have a beautiful
smile. But we don't have to worry about taking out teeth because there's plenty of bone there to
hold all those roots. That's the goal we have. So when they're in middle school, they get the
aesthetic alignment and the bite coordination, all the good things, but they don't have to worry
about the size of the space. Right. Because that would have already been taken care of.
That's extremely good. And what age, just because I want to hear you say it,
because I was surprised about this. Again, as what age should or, well, I'm going to use the word
should. Should you start taking a child to the dentist? Well, before age one. Yeah. I think
that blows my mind. Yeah. Well, because it blows my mind too. I don't treat, as you know, I don't
treat little kids. Right. I've never treated little kids. My dental practice was an adult
dental practice. I'm super passionate about treating little kids in other people's offices
because because they can't. And so important. So the media and dentists have all the behavioral
training to start a child before age one on things that could be done age appropriate for that. Now,
we're not going to put any little experience standards in a one year old. That's not going to
work. Right. But what we can pay attention to is, are they breathing through the mouth? Is there an
allergy problem? Is there even a tongue position? Sharon Moore, another future guest of yours.
She talked last night about a child that she's seeing this a year and nine months. And so,
before age two there, and this child has special needs, but all the things that Sharon was talking
about, she could do. We, on the listening to her talk, were understanding she could do that on
non-special needs children even before age one. Because there's amazing things that parents can do,
in this case mostly moms, but can do for their 12 months, their 10 months old, to get them on the
right track. Right. Such as what are just a couple of them? Yeah. Here's an easy one. If a mom of a
newborn or a few months old notices mouth breathing, there's cultures with it. The standard is just
the mouth, the mom reaches over, just holds her lips again. You don't have to do anything fancy,
just hold lips together. Start a good habit of nose breathing. Of course, there's a whole bunch
of things that can be learned about breastfeeding and tongue position of that and how to swallow.
Is there a tissue that has to be removed? And several things about that that are all detailed,
but you'll have future programs here. Because even at nursing time, breastfeeding time,
first six months, eight and a half, and all at last, that starts the whole process of muscle
training and bone development of the cranial ischolesteroid complex. Right. When a pediatric
dentist gets involved before age one, when a family dentist gets involved, maybe at three
or four or five, then we can start to recognize these troubles as early in life as possible
and intervene as early in life as possible. Right. When they're still valuable and we can make a
dentist. Because the bone is all plastic during those years. It can be pushed around.
And if we recognize deficiency and growth, well, isn't it better to aim that growth at the right
target? Yeah, absolutely. Absolutely. Because we'll do it later on in teenage years and adult years.
I can really talk quality orthodontist Dr. Bacow in my town. I'm not going to do surgical procedures
and move the bones around in 60-year-olds, but isn't it better at six? Right. Agreed. Agreed.
And I know we touched on this briefly, but as far as your concept and your ideal, how should,
going forward, in the best scenario, airway-centric dentists and pediatricians, how should they be
collaborating and working together? Sure. So a child goes to a, typically goes to a pediatrician
for some well-child visits, but oftentimes they're in there because of a complaint. You know, a cold,
allergies, you know, they're not doing well. Well, if a child just isn't doing well,
what would be the reason for that? And so the pediatricians' eyes are opened for seeing
mouth breathing, for seeing, you know, a bad habits that way. That's how it doesn't seem to fit,
quote, in the mouth. Those are the things that can be addressed early in life. But the pediatrician
doesn't have to know how to do that. That's, they're not trained in this either. So they sit into the
right pediatric dentist who now is, and the pediatricist says, okay, on this team, I'm going
to need some habits, have it correcting. My dental assistant can help you with that. I have a speech
and language pathologist with training and myofunctional therapy that can help you with that.
I have dental hygiens for training and myofunctional therapy that can help you with that. And by the way,
this jaw structure is too narrow here and sent back too far. And so for your child,
parent, let's think about doing this little extender or this habit corrected. There's
out of the shelf habit correctors that these kids can use where they just bite on this thing
and it helps train the muscles. They helps to shape the bone, helps to train the tongue.
All of these come with exercises. So, um, there's some real popular ones are healthy start and
mild brace, uh, u control. There's several of these kinds of things out there that can let every
dentist who gets trained on this by some of the organizations we talked about earlier
can, uh, use some of these protocols to give families an easy solution. You know,
it's not difficult for a child to accept that they have to, you know, chew on this little thing for
an hour a day while they're playing. Cause if you make that a routine, the kid goes,
no, I can do that. Yeah, they just do it. Yeah. We watch the videos, they play the games,
they do all the cool things that are made for kids. And sure enough, they get themselves out of
trouble. And they go to the pediatrician for the next one and the pediatrician says, what happened
to your child? They used to be listless. Now they're full of energy or even better, they used to be
uncontrollable full of energy and now there's a thermal. Right. Which is something that, that I,
I think is interesting that, um, hypoxic brain injury. So you'll see kids with lowering IQs,
ADHD kids are getting labeled with that. And it turns out it's an airway issue. Right.
Not always, but a lot of times it is. Yeah. Steven Sheldon, one of our Steven Sheldon,
a physician in Chicago, he's a DO, uh, sleep specialist up in Chicago at Larry Children's.
He's one of our, you know, global heroes in this. He actually says he doesn't think ADHD exists.
He thinks it's a brain response to other problems. And the other problem that's the
primary one is breathing issues. Breathing, which is amazing. Yeah. So I'm not sure I agree. I'm
serving out a diagnostician for ADHD, but, um, but some kids have, uh, so too many kids have
benefited from the medications to say it doesn't exist in my view. But I think the vast majority
of those kids haven't been, uh, uh, I haven't been evaluated for breathing issues. Right. And so,
so I think that no child should be put on a ADHD medication without being evaluated for
breathing issues by a competent dentist or an orthodontist is trained in the craniofacial
respiratory complex. Right. I would agree with that. Um, so you've mentioned a couple of
organizations and I just want to give you a moment and opportunity to speak about those.
Yeah. We've talked about the AAPMD and the ASAP. Um, and then I see behind you, you've got your
your collaboration cures 2022. Yeah. So, uh, you know, share a little bit about that with people
about these organizations and your involvement and what they do. Well, um, the American
ville association, the group for dentists passed a policy statement for airway issues a few years
ago, 2017. So that got the ADA on board. And as those of us that have started to expand our
practices into more and more airway, we've also come together in subgroups and a APMD. Uh, and
another, there's several of them, a gosh, American Academy of Oral Systemic Health and some others
have realized that, wow, you know, restoration and breathing patterns, they are the fundamental.
We're trying to help you get healthy across the board. We can't do that if they don't breathe well.
Right. So, um, you know, being small groups of dentists that are passionate about a certain
subject, we find each other and we then start to think, what can we learn from each other?
And it turns out there's physicians and there's physical therapists and there's speech and language
pathologists all on the same kind of thinking path playing. We're going to get it once a year
and they call it collaboration cures because it's putting everybody together to try and find a way
out of this health problem that we have. And in 2022, it's going to be in September in Phoenix.
And it's filled with speech and language pathologists and physical therapists and physicians
and dentists and functional medicine folks. And we're all coming together to learn from each other
and to sit in a conference room and hear a great lecture to go through a workshop to
have a mixer where we, you know, sit out with our DO colleagues or our PTs that we've never talked to
before and say, what can you do to help me understand the creative facial respiratory complex even better?
And what can I do to help you? I mean, it's just all of that. It's just a fantastic group. It's my
favorite event of the year is to go to collaboration college, a graduation cures.
And I said it and I believe in that where did you meet? No, that's not where you met Candy.
No, I met her earlier in the year. Different meeting in my therapy group. Yeah. Yeah, that was awesome.
But you know, it's just, and I'm going to any of these is empowering because when you go to,
you know, when dentists can speak from a dentist sample, we go to a dental conference.
There's so much going on. There's lectures about vast numbers of subjects. There's a giant
exhibit and finding a small group of people that are passionate about a something that just really
excites you is more difficult. You go to a smaller meeting, like a malfunction meeting,
and you're ready to a candy sparks. And you realize, wow, you know, look at the energy right here.
There's that's attractive. So I want to find out more about that. And so I sit down with a candy
spark. So I sit down with a Brad Guilden, a physical therapist. I sit down with a Sharon Moore, the SLP,
and I learned what drives that. And they hear what drives me. Right. And we all work together.
And it's really, it's really fun and energized again, changing. And it's changing. Yeah, you
do it a lot of conferences, and you go away and you don't do anything different because you don't
learn much. Right. You go to a focus group like collaboration cures. And man, you come away from
there and you can't not change what you do. Right. And it sparks this conversation and it pulls
people together and it creates these little subgroups become bigger groups and we're becoming a
bigger and bigger movement, so to speak. I'm not sure what the right term is, but it's group.
You know, we're all working, going towards the same goal, all driving together.
And, you know, people gather together in small groups like this with this kind of passion.
They don't have what we call it, agendas that require them to hold back information.
Right. Their agenda is to spread it out. Right. And so the kind of people that I think of is like,
you know, there's more pie than anybody can eat. And so the more we talk about the bigger the pie
gets. And so there's no reason to hoard my piece of the pie. Right. I got plenty of pie. So let me
tell you what I know. You tell me what you know. Right. And that makes us stronger too. Right.
Right. What's that old quote? If I have an apple and you have an apple and we exchange apples,
we each have an apple. But if I have an idea and you have an idea, now we exchange those and we each
have two ideas. Right. So multiply that across 800 people with collaboration cures, you know,
and look what happens. Right. It is definitely powerful. It is. Well, I thank you so much for
being on our podcast and for all the work you're doing. Thank you so much. Well, it's such a lot
of pleasure. You know, this is this is why you might be able to tell I'm energetic about this.
I know. I appreciate that. Thank you. And thank you for you and the Children's Airway
First Foundation. I think it's new. It's a year old. Congratulations. Thank you. And the work that
you and Candy and Brad and the other advisory council are doing all my heroes on the advisory
council. I mean, this is going to be something that's going to be a game changer for our profession.
And that changes the world. It's absolutely what we're after.
A huge thank you to today's guest, Dr. Steven Carsonson, for sharing his medical insight
and to each of you for listening to today's episode. If you're new to our podcast, please
don't forget to subscribe. And if you enjoyed today's episode, please remember to leave us a review
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the parents and medical professionals out there that are working to help make the lives of kids
around the globe just a little bit better. Take care, stay safe and happy breeding, everyone.